19th, I was called to visit him early in the morning, on account of a bleeding at the nose which had come on: he lost about eight ounces of blood, which was of a loose texture: the hæmorrhage was suppressed, though not without some difficulty, by means of tents made of soft lint, dipped in cold water strongly impregnated with tincture of iron, which were introduced within the nostrils quite through to their posterior apertures; a method which has never yet failed me in like cases. His tongue was now covered with a thick black pellicle, which was not diminished by drinking: his teeth were furred with the same kind of sordid matter, and even the roof of his mouth and sauces were not free from it: his looseness and stupor continued, and he was almost incessantly muttering to himself: he took this day a scruple of the Peruvian bark with ten grains of tormentil every two or three hours: a starch clyster, containing a drachm of the compound powder of bole, without opium, was given morning and evening: a window was set open in his room, though it was a severe frost, and the floor was frequently sprinkled with vinegar.

20th, He continued nearly in the same state: when roused from his dozing, he generally gave a sensible answer to the questions asked him; but he immediately relapsed, and repeated his muttering. His skin was dry, and harsh, but without petechiæ. He sometimes voided his urine and fæces into the bed, but generally had sense enough to ask for the bed-pan: as he now nauseated the bark in substance, it was exchanged for Huxham's tincture, of which he took a table spoonful every two hours in a cup full of cold water: he drank sometimes a little of the tincture of roses, but his common liquors were red wine and water, or rice-water and brandy acidulated with elixir of vitriol: before drinking, he was commonly requested to rinse his mouth with water to which a little honey and vinegar had been added. His looseness rather increased, and the stools were watery, black, and fœtid: It was judged necessary to moderate this discharge, which seemed to sink him, by mixing a drachm of the theriaca Andromachi with each clyster.

21st. The same putrid symptoms remained, and a subsultus tendinum came on: his stools were more fœtid; and so hot, that the nurse assured me she could not apply her hand to the bed-pan, immediately after they were discharged, without feeling pain on this account: The medicine and clysters were repeated.

Reflecting upon the disagreeable necessity we seemed to lie under of confining this putrid matter in the intestines, lest the evacuation should destroy the vis vitæ before there was time to correct its bad quality, and overcome its bad effects, by the means we were using; I considered, that, if this putrid ferment could be more immediately corrected, a stop would probably be put to the flux, which seemed to arise from, or at least to be encreased by it; and the fomes of the disease would likewise be in a great measure removed. I thought nothing was so likely to effect this, as the introduction of fixed air into the alimentary canal, which, from the experiments of Dr. Macbride, and those you have made since his publication, appears to be the most powerful corrector of putrefaction hitherto known. I recollected what you had recommended to me as deserving to be tried in putrid diseases, I mean, the injection of this kind of air by way of clyster, and judged that in the present case such a method was clearly indicated.

The next morning I mentioned my reflections to Dr. Hird and Dr. Crowther, who kindly attended this young gentleman at my request, and proposed the following method of treatment, which, with their approbation, was immediately entered upon. We first gave him five grains of ipecacuanha, to evacuate in the most easy manner part of the putrid colluvies: he was then allowed to drink freely of brisk orange-wine, which contained a good deal of fixed air, yet had not lost its sweetness. The tincture of bark was continued as before; and the water which he drank along with it, was impregnated with fixed air from the atmosphere of a large vat of fermenting wort, in the manner I had learned from you. Instead of the astringent clyster, air alone was injected, collected from a fermenting mixture of chalk and oil of vitriol: he drank a bottle of orange-wine in the course of this day, but refused any other liquor except water and his medicine: two bladders full of air were thrown up in the afternoon.

23d. His stools were less frequent; their heat likewise and peculiar fœtor were considerably diminished; his muttering was much abated, and the subsultus tendinum had left him. Finding that part of the air was rejected when given with a bladder in the usual way, I contrived a method of injecting it which was not so liable to this inconvenience. I took the flexible tube of that instrument which is used for throwing up the fume of tobacco, and tied a small bladder to the end of it that is connected with the box made for receiving the tobacco, which I had previously taken off from the tube: I then put some bits of chalk into a six ounce phial until it was half filled; upon these I poured such a quantity of oil of vitriol as I thought capable of saturating the chalk, and immediately tied the bladder, which I had fixed to the tube, round the neck of the phial: the clyster-pipe, which was fastened to the other end of the tube, was introduced into the anus before the oil of vitriol was poured upon the chalk. By this method the air passed gradually into the intestines as it was generated; the rejection of it was in a great measure prevented; and the inconvenience of keeping the patient uncovered during the operation was avoided.

24th, He was so much better, that there seemed to be no necessity for repeating the clysters: the other means were continued. The window of his room was now kept shut.

25th, All the symptoms of putrescency had left him; his tongue and teeth were clean; there remained no unnatural blackness or fœtor in his stool, which had now regained their proper consistence; his dozing and muttering were gone off; and the disagreeable odour of his breath and perspiration was no longer perceived. He took nourishment to-day, with pleasure; and, in the afternoon, sat up an hour in his chair.

His fever, however, did not immediately leave him; but this we attributed to his having caught cold from being incautiously uncovered, when the window was open, and the weather extremely severe; for a cough, which had troubled him in some degree from the beginning, increased, and he became likewise very hoarse for several days, his pulse, at the same time, growing quicker: but these complaints also went off, and he recovered, without any return of the bad symptoms above-mentioned.

I am, Reverend Sir,
Your obliged humble Servant,
Wm. Hey.